Hordes of inmates are ill

Fractured system plagued by problems

Law enforcement authorities are regularly encountering people with mental illness and others with severe emotional problems. Among them are a number of people who call police constantly when they are in crisis.

NEWPORT, R.I. — Inside a cluttered downtown apartment that she shares with a cat, the 57-year-old woman is in the midst of a near-meltdown.

The police have been here before — 61 times, in fact, in the past 17 months — and the only intruders to be found are the ones apparently stalking the woman's troubled psyche.

During these episodes, she always summons the police because they are the closest thing she has to family. And no matter what, they always come.

"I didn't have any choice but to go to Jimmy,'' she said, waving the glowing end of her lighted cigarette in the direction of Officer Jimmy Winters. "I'm sorry I'm such a pain in the ass.''

In the shadow of enormous wealth, where tourists flock to view the iconic mansions along Bellevue Avenue, about 40% of all calls to police involve people who are mentally ill or have behavioral problems. It is, as Newport Chief Gary Silva described it, an "alarming'' number. Yet it only begins to assess how an overwhelmed criminal justice system has become the de facto caretaker of Americans who are mentally ill and emotionally disturbed.

From police departments and prisons to courthouses and jails, the care of those who are mentally ill weighs heaviest on law enforcement authorities, many of whom readily acknowledge that they lack both resources and expertise to deal with the crushing responsibility.

In a series of stories in the coming months, USA TODAY will explore the human and financial costs the country pays for not caring more about the nearly 10 million Americans with serious mental illness.

About 1.2 million people in state, local and federal custody reported some kind of mental health problem, a 2006 Justice Department analysis concluded. It is among the most recent national assessments of prisoners' mental status.

Though the report included a broad definition of "problems'' — from mere symptoms to severe illness — the numbers represented 64% of those in jails, 56% of state prison inmates and 45% in the federal prison system.

This 57-year-old Rhode Island woman with a history of mental problems has called the police 61 times in the past 16 months.(Photo: David DelPoio for USA TODAY)

In one of the largest detention systems in the nation, Chicago's Cook County Jail, the problem is so persistent that Sheriff Tom Dart keeps a running tally of the incoming mentally ill cases on his Twitter account.

On average, at least 30% of the 12,000 inmates suffer from a "serious'' mental illness, though the sheriff said the estimate is "a horrifically conservative number.'' One of those inmates, Dart said, was a "chronic self-mutilator'' who has been arrested more than 100 times, ringing up more than $1 million in repeated arrest- and detention-related costs.

Another inmate, the sheriff said, recently had to be fitted with a hockey mask and thick gloves resembling oven mitts to keep him from gouging out his remaining eye. The 43-year-old man, suffering bipolar disorder and schizophrenia, had ripped one eye from the socket before his arrival at the jail, complaining that he "didn't want to see evil anymore.''

Cook County, Ill., Sheriff Tom Dart runs one of the largest local jails in the U.S. It also has become a repository for people with mental illness. At least 30% of inmates have been diagnosed with some form of mental illness.

“They end up here (the criminal justice system), because we are the only system that can't say no.”

Cook County Sheriff Tom Dart

Dart refers to a constant cycle of arrest and incarceration, mostly involving minor offenses and the poor who are unable to make bail, as the "criminalization of the mentally ill.''

On America's streets, police encounters with people who are mentally ill and/or emotionally disturbed are increasingly directing resources away from traditional public safety roles. It is not uncommon at many police departments, according to the National Alliance on Mental Illness, for more than 20% of daily calls for service to involve people who are emotionally disturbed.

In the most serious of these encounters — a recent welfare check on a young California man before a deadly killing spree in June that left six dead near Santa Barbara; and a police visit to a hotel here last year where a military contractor reported hearing voices weeks before killing 12 at the Washington Navy Yard — cops are making dangerous life-and-death diagnoses perhaps best left to doctors.

“Law enforcement did not ask for this additional challenge.”

Sen. Dick Durbin, D-Ill.

"Law enforcement did not ask for this additional challenge,'' Sen. Dick Durbin, D-Ill., said at a recent congressional hearing. "It was forced upon them by factors out of their control."

Durbin referred to a long de-institutionalization movement across the nation that has resulted in the shuttering of state hospitals in favor of community mental health centers. The network of facilities never emerged as lawmakers envisioned when Congress passed the Community Mental Health Centers Act in 1963.

"The only way we could justify shutting down hospitals is to make way for the emergence of new medication or treatment that allowed for sick people to be treated in another way,'' Dart said. "That didn't happen. They end up here (the criminal justice system), because we are the only system that can't say no. When they are charged with crimes, no matter how minor, we have to take them.''

Taken away in cuffs

Exhausted cops transport those needing help all over the state

​

Every other day, on average, Tulsa police load a handcuffed passenger into a patrol car and begin an often long and expensive journey that ends nowhere near a jail or courthouse.

Since January 2011, Tulsa police have logged 186,636 miles and racked up tens of thousands of dollars in overtime in search of available beds for mentally ill people in need of emergency treatment.

Tulsa police officer Wayne Wilcox talks with a mental health patient who requested to be transported after seeing animals in her house that were not there. Every other day, on average, Tulsa police officers load a handcuffed passenger into a patrol car and begin an often long and expensive journey that ends nowhere near a jail or courthouse. (Photo: Shane Bevel for USA TODAY)

Tulsa police officer Robert Heidlage talks with a woman who requested transport to the Tulsa Center for Behavioral Health. Since January 2011, Tulsa police have logged 186,636 miles and racked up tens of thousands of dollars in overtime in search of available beds for the mentally ill in need of emergency treatment. (Photo: Shane Bevel for USA TODAY)

Tulsa police officers Robert Heidlage, right, and Wayne Wilcox place a woman in a patrol car, in handcuffs, who requested transport to the Tulsa Center for Behavioral Health. Handcuffs are required for all passengers of police officers, including those being transported for mental health reasons. (Photo: Shane Bevel for USA TODAY)

Sgt. Bryan Bryden watches TV with officer Wayne Wilcox at the Family and Children's Services CrisisCare Center in Tulsa. The officers transported a mental health patient there and are required to wait until the patient has been assessed until they can return to patrol. (Photo: Shane Bevel for USA TODAY)

Sgt. Bryan Bryden, left, and officer Wayne Wilcox wait for a patient at a health center in Tulsa. Since January, 2011, Tulsa police have logged 186,636 miles and racked up tens of thousands of dollars in overtime in search of available beds for the mentally ill in need of emergency treatment. (Photo: Shane Bevel for USA TODAY)

Like this topic? You may also like these photo galleries:

Some transports, which require two officers per trip as a safety precaution, can consume an entire eight-hour shift when the destination is the state's most distant facility — a 434-mile round-trip to Fort Supply, a tiny former cavalry outpost in far-west Oklahoma.

For years, Tulsa and other Oklahoma law enforcement agencies have been required under state law to transport people suffering mental problems millions of miles for emergency treatment at facilities around the state. The program highlights on a near-daily basis how deeply intertwined the national criminal justice and mental systems have become. At the same time, the forced-collaboration is straining limited law enforcement resources and raising questions about the treatment of hundreds of sick people who often are treated no differently than criminal suspects.

From 2009 to 2011, according to a 2012 analysis by the Council of State Governments Justice Center, mental health transports by Oklahoma police increased by 45%.

“Police should not be involved in this process at all, but nobody else can or wants to do it.”

Tulsa police Maj. Tracie Lewis

"It is simply overwhelming,'' said Tulsa police Maj. Tracie Lewis, who manages the department's transport system. "Police should not be involved in this process at all, but nobody else can or wants to do it.''

In 2013, Oklahoma police agencies traveled nearly 1 million miles with mentally ill patients, according to records maintained by the Oklahoma Department of Mental Health and Substance Abuse Services.

The state reimbursed the agencies $519,333 for the mileage, but Lewis and other officials said other related costs, including tens of thousands of dollars in necessary overtime and the loss of police coverage from neighborhoods, are difficult to reconcile.

Police officers respond to calls for emotional issues by taking people to mental health centers in Tulsa, Oklahoma. In many instances, that means two officers drive hundreds of miles to find an available bed.

In Tulsa, for example, many of the officers required to staff the 267 out-of-town mental illness trips in 2013 normally would have been patrolling the city's streets or responding to calls involving possible crimes.

In cases when officers encounter people in need of emergency care — those who represent a danger to themselves and/or others — police are required to transport them to the nearest available treatment facility.

Oklahoma Department of Mental Health Commissioner Terri White said that because the need is so great and there are so few emergency beds available in the state's second-largest city, police regularly crisscross the state, sometimes in the middle of the night, to find appropriate care for those in crisis.

Tulsa police logged the most miles in 2013 of any state law enforcement agency — 63,819 miles — which prompts increasing concern about the physical toll on the city's officers.

To combat fatigue, Lewis said the department has been drawing some of the two-officer driving teams from the off-duty ranks, especially in cases when on-duty officers slated to transport sick patients are nearing the end of their shifts.

"The (off-duty officers) have done so much driving that the list of volunteers is getting shorter and shorter because they are getting tired, too,'' Lewis said.

Lewis and White also expressed concern for the manner in which mentally ill patients are transported.

Tulsa police Maj. Tracie Lewis calls mental health facilities at the beginning of a shift to check on the availability of beds.(Photo: Shane Bevel for USA TODAY)

"They are put in handcuffs and transported hundreds of miles at a time,'' White said. "It is unconscionable; no other disease gets transported this way.''

As unsettling as the transportation method may be, White and Lewis acknowledge there is no other alternative. Absent other options, they said handcuffs are probably a necessary precaution to keep some patients from hurting themselves or the officers or attempting to jump from the vehicles. Both said ambulances or other traditional medical transports would be preferable.

"There is definitely a better way to do this,'' White said, "but it would take an investment in dollars that no one is willing to make.''

"It's just wrong,'' Lewis said.

A gunshot, and a teen dies

Not all officers are trained to deal with mental patients

Mary Wilsey, whose son was shot and killed by police after they responded to a mental episode at her home, is taking her message for better training to anyone who will listen.

When police were summoned to Keith Vidal's North Carolina home shortly after noon Jan. 5, it was not the first time.

Since Vidal, 18, was diagnosed with schizophrenia in the spring of 2013, his mother, Mary Wilsey, said officers had been called to the house on President Drive multiple times, often to assist when Vidal's medications "weren't working'' or when he needed some persuasion to seek additional help at a hospital.

On every previous occasion, Wilsey said, the officers "truly tried to help this child get help.''

Then came that Sunday afternoon in January. Before sunset, a new controversy had erupted over how police respond to calls involving mental illness.

It started with a 911 call to Brunswick County authorities in which Vidal's stepfather, Mark Wilsey, displayed unusual calm while describing a then-familiar scenario.

"He's not doing very good,'' the stepfather said of Vidal, adding that the schizophrenic young man was confronting his mother. There was a brief reference to "medication'' and that he had been holding a screwdriver.

Mary Wilsey of Southport, N.C., sits in her son's room, reflecting on the events of his death. Keith Vidal was fatally shot by police after they were asked to come to the home for help during an emotional episode.(Photo: Randall Hill for USA TODAY)

"We got to get him someplace,'' he said. "She's (the mother) scared to death of him.''

Within minutes, Boiling Spring Lakes, N.C., police Officer John Thomas arrived at the home, followed by Brunswick County Deputy Sheriff Samantha Lewis. Thomas, Mary Wilsey said, had been to the home before, and he began speaking quietly with Vidal before he was joined by the deputy.

"There was no yelling,'' the mother said.

Mary Wilsey said the situation "quickly escalated'' with the arrival of a third officer, Southport, N.C., Det. Bryon Vassey, who had never been to the house on previous calls.

In short order, according to Mary Wilsey, the detective directed the other officers to use their stun guns to resolve the standoff, prompting her son to attempt to flee. Seconds later, she said, the slightly built Vidal — about 5-feet-5 and 120 pounds — was on the floor with Thomas and Lewis on top of him.

Then, there was gunfire. The mother said Vassey fired his weapon into the scrum, fatally wounding Vidal.

"Keith,'' she said, "started to bleed out on my floor.''

Vassey was not available for comment. His attorney, W.James Payne, said the detective fired to protect the two other officers from Vidal, who he said was attempting to stab' one of the officers on the floor with a pick-like instrument.

The detective, Payne said, fired "in defense of others.''

A grand jury came to a different conclusion in February, when the panel issued an indictment charging Vassey with voluntary manslaughter. Thomas and Lewis were cleared of any wrongdoing.

Brunswick County District Attorney Jon David said in a briefing after the charge was announced that his review of the evidence led him to a similar conclusion: "a crime almost certainly occurred — that it was a 'bad shoot.' ''

Lessons from a fatal shooting

A call goes out for special officer training

Though the criminal case against Vassey is pending, David said in the post-indictment briefing that the incident should serve as a "teaching moment'' for police encounters with cases involving mental illness.

Days after the fatal shooting, David said he convened a meeting of county law enforcement officials where "all recognized the significance of what occurred'' and the need for additional police training for such encounters.

"There was a commitment to learn from this,'' David said.

Two months after the indictment was issued in North Carolina, the National Alliance on Mental Illness in Washington, a leading advocate for mental health in the USA, called for the creation of special units in law enforcement agencies across the country to help deal with calls involving those who are mentally ill or have disabilities or behavioral problems.

Of the more than 17,000 police agencies in the country, slightly more than 2,700 have established so-called Crisis Intervention Team (CIT) programs modeled after a Memphis unit created 25 years ago in the wake of a fatal incident.

NAMI's announcement in April did not mention the North Carolina case, but it echoed the same themes expressed by the Brunswick County district attorney.

Mary Wilsey holds a family photo of her son Keith Vidal at her home in Southport, N.C.(Photo: Randall Hill for USA TODAY)

"Police are often the first responders when a person is in psychiatric distress,'' the group said in a written statement. "Every community owes it to them to provide the knowledge and training to handle safely and compassionately mental health crisis situations.''

At least 30 police department CIT coordinators who responded last month to a survey conducted by University of Memphis professor Randolph DuPont and USA TODAY reported that behavioral crisis events were increasing in their communities.

Respondents, a mix of urban, suburban and rural agencies, said the crisis calls represented nearly one of every five calls for service to their departments. In those cases, the calls took slightly more than one hour to resolve — or twice as long as other calls for service.

DuPont, a clinical psychologist who has helped develop the CIT programs, said the relatively small number of survey respondents does not offer definitive conclusions. But it does highlight some of the difficult challenges confronting law enforcement agencies.

The Chicago Police Department, the third-largest in the country, is one of the agencies that have adopted the special training. Even there, the need outstrips the available resources.

“When my son died, I wanted to prevent another family from going through another terrible tragedy.”

Mary Wilsey, whose son was fatally shot

Although nearly 2,000 officers have completed 40 hours of training, that number represents less than 20% of the entire force. According to department records, there are not enough CIT-trained officers in Chicago to respond to the majority of mental health calls.

"Thus the outcomes of many thousands of mental-health-related calls were not benefited by interaction with an appropriately trained officer, and thereby adding unnecessary risk of physical altercation and bodily harm during those calls,'' First Deputy Police Superintendent Alfonza Wysinger told a Senate panel this spring.

In North Carolina, Mary Wilsey is attempting to channel her grief into a legislative campaign that would require every officer in the state to undergo special training to respond to calls involving those who are mentally ill or have disabilities or behavioral problems.

Republican State Rep. Frank Iler said he will attempt to formally offer the proposal during the 2015 legislative session.

"If this officer (Southport Det. Vassey) had been trained to handle a mentally ill child, (Vidal) would still be alive,'' Wilsey said.

Southport Chief Jerry Dove said just two of his officers had received such training at the time of the incident, but neither was on duty that day.

"When my son died, I wanted to prevent another family from going through another terrible tragedy,'' Wilsey said of her campaign. "Why would we not want this?''

A call for help, then Navy Yard

Aaron Alexis and the 'vibrations' in his body

A similar debate probably would not be playing out in Newport, R.I., if it weren't for a call for help placed last August by a clearly disturbed man occupying Room 405 at the Marriott Hotel.

When Newport Officers Seth Mosely and Eric Cormier arrived early that morning, there was little to indicate the call was much different from the crush of others in Newport involving the mentally ill or emotionally disturbed.

Police Chief Silva said nothing' during the course of the call warned that Aaron Alexis, 34, may have been contemplating the violence he unleashed a month later in Washington during a shooting rampage at the Navy Yard.

Since that assault, which left Alexis and 12 others dead, Silva and police Lt. William Fitzgerald said they have examined and re-examined the Newport police encounter Aug. 7 with Alexis, who complained of being pursued by three unknown people who were "sending vibrations into his body.''

Aaron Alexis moves through the hallways of a building, carrying a Remington shotgun.(Photo: Getty Images)

The Navy contractor told the officers he had moved from two hotels to escape his "pursuers'' before settling at the Marriott where "some sort of microwave machine'' was being used to send vibrations through the ceiling that penetrated his body.

Within hours of the Navy Yard shooting a month later, one of the responding Newport officers alerted his bosses of the Marriott encounter, which launched an examination of the brief, 19-line police report prepared by Mosely. It is a document, Silva said, that is used as a training tool within the department.

Silva has defended his officers' actions, saying they reported the encounter to the Navy base where Alexis was working. A copy of the police report was sent to naval security officers, but it was never forwarded to higher military authorities.

"I don't think I would have done anything differently,'' Silva said. "I can't tell you how much we went over and over that report.''

Some officials suggest more could have been done had police enlisted the help of mental health experts to assess Alexis' condition.

“Some are looking to the police department to do things that you never imagined. Dealing with the mentally ill is part of that.”

Newport, R.I. police Lt. William Fitzgerald

"We could have assessed him and hospitalized him,'' she said.

Bartolomucci and Francis Paranzino, the Newport mental health center's chief operating officer, said that even if there is mental health intervention, "you can't guarantee the outcome.''

Silva and Fitzgerald said the Alexis incident and the continuing stream of mental health calls underscore how much the role of policing has changed and expanded.

"We have people who call us and want us to solve all their problems,'' Fitzgerald said. "They got no milk, they don't know what time it is, they can't get their kid out of bed.

"We have been integrated into their daily lives,'' he said. "Some are looking to the police department to do things that you never imagined. Dealing with the mentally ill is part of that. And we've never been equipped to do half of these things.''